2-12-2013 DTA storm-related SNAP replacement benefits

2-12-2013 DTA storm-related SNAP replacement benefits

Winter Storm Nemo Assistance
SNAP Household Misfortune Replacement Benefits
February 12, 2013
February 12, 2013
Dear Community Partner:
Winter storm Nemo passed through New England on February 8 and 9, bringing significant
damage to a number of communities. High snow fall combined with significant wind conditions
has caused widespread power outages across much of the Massachusetts coast.
SNAP Replacement Benefits
Households receiving SNAP may apply to the Department of Transitional Assistance (DTA)
for SNAP “replacement benefits” due to household misfortune. Affected households who
receive SNAP benefits may request replacement of food lost due to household misfortune, such
as an extended power outage of at least four hours, a flood, or an equipment failure (such as a
refrigerator or freezer). Replacement is limited to the value of the food lost or damaged, not to
exceed the total monthly SNAP benefit amount the household received.
DTA has applied to USDA for a waiver to provide “mass/automatic replacement benefits” to
some households living in Barnstable, Bristol, Dukes, Nantucket, Norfolk and Plymouth
Counties. If granted, DTA would automatically replace 40% of these households’ February
SNAP benefits. If it is granted, DTA will notify community partners immediately.
Application Deadline
Households must begin the replacement benefit application process within 10 days of the loss.
Because the storm and power loss occurred on February 8 and 9, households must report their
loss associated with this storm by the end of the day on Tuesday, February 19, 2013. Note that
they must then return a signed and completed statement of loss within 10 days of reporting the
food loss.
DTA may apply to USDA for an extension of this deadline. If it is granted, DTA will notify
community partners immediately.
Process for Applying
To receive replacement benefits:

Clients must report the loss of food by phone, in person or in writing to DTA within 10
days of the loss. We estimate that for most households, the loss would have occurred on
February 8 or 9; therefore, they should apply by Tuesday, February 19.

Return a signed and completed Statement of Loss/Request for Replacement Food Due to
a Household Disaster or Misfortune (SNAP-9B) form (attached) to the local DTA office
within 10 days of reporting the loss. Note: If the tenth day falls on a weekend or holiday,
and the statement is received the next business day, DTA will consider the request to be
timely.

Provide verification of the household misfortune.
o However, if the household lives in one of the coastal counties that DTA has
verified had significant power outages, DTA will not require third party
verification. Instead, households can simply submit the SNAP 9-B form
(attached). The list of communities follows.
o If the household does not reside in one of these communities, they must provide a
verification of the household misfortune by a third party. Examples of third
parties who can provide verification include the Red Cross, utility company, fire
department or by a person outside of the household.
Cities and Towns Exempt from the Requirement of Third Party Verifications
Cities and towns in Barnstable, Bristol, Dukes, Nantucket, Norfolk and Plymouth Counties:
Abington
Acushnet
Aquinnah
Attleboro
Avon
Barnstable
Bellingham
Berkley
Bourne
Braintree
Brewster
Bridgewater
Brockton
Brookline
Canton
Carver
Chatham
Chilmark
Cohasset
Dartmouth
Dedham
Dennis
Dighton
Dover
Duxbury
East Bridgewater
Eastham
Easton
Edgartown
Fairhaven
Fall River
Falmouth
Foxborough
Franklin
Freetown
Gosnold
Halifax
Hanover
Hanson
Harwich
Hingham
Holbrook
Hull
Kingston
Lakeville
Mansfield
Marion
Marshfield
Mashpee
Mattapoisett
Medfield
Medway
Middleborough
Millis
Milton
Nantucket
Needham
New Bedford
Norfolk
North Attleboro
Norton
Norwell
Norwood
Oak Bluffs
Orleans
Pembroke
Plainville
Plymouth
Plympton
Provincetown
Quincy
Randolph
Raynham
Rehoboth
Rochester
Rockland
Sandwich
Scituate
Seekonk
Sharon
Somerset
Stoughton
Swansea
Taunton
Tisbury
Truro
Walpole
Wareham
Wellesley
Wellfleet
West Bridgewater
West Tisbury
Westport
Westwood
Weymouth
Whitman
Wrentham
Yarmouth
Commonwealth of Massachusetts
Department of Transitional Assistance
Statement of Loss/Request for Replacement Food
Due to a Household Disaster or Misfortune
I, _________________________________________, SSN _________-_______-_______________
(Print Full Name)
EBT Card # ________________________________
of ________________________________________________________________________________
(Street, City, State, Zip Code)
am in need of replacement food because food I purchased with my Supplemental Nutrition Assistance
Program (SNAP) benefits, in the amount of $___________________, was destroyed in a household
disaster/misfortune.
The household disaster/misfortune that occurred on _____/______/_________was: (Explain)
(Date)
___________________________________________________________________________________
___________________________________________________________________________________
I can be contacted at (_______) _________-________________
(Telephone Number)
The information I have given in this statement is correct and true.
I understand that if I intentionally made a false or misleading statement about the destruction of my food
purchased with SNAP benefits, I may be charged with perjury or subject to an Intentional Program
Violation. If I am found to have committed an Intentional Program Violation, I will be ineligible for
SNAP benefits for 12 months for the first violation, 24 months for the second violation, and permanently
for the third violation.
________________________________________
________/______/_____________
Date
Head of Household Signature
________________________________________
________/______/_____________
Date
Witness Signature
The occurrence of the household disaster/misfortune outlined above was confirmed by:
Home Visit on ______/______/___________
Date
Collateral Contact with ______________________________on ______/______/___________
Name
Date
Documentation from ________________________________on ______/______/___________
Community Agency
____________________________________________________
Case Manager
SNAP-9B (Rev. 11/2011)
09-010-1111-05
Date
_______/_____/___________
Date
Original to Case Record – Copy to Client
Commonwealth of Massachusetts
Department of Transitional Assistance
Aviso de Perdida/Solicitud de Reemplazo de Alimento
Debido a una Desgracia en el Hogar o Infortunio
Yo, _________________________________________, SSN _________-_______-_______________
(Nombre (en letra de imprenta))
EBT Card # ________________________________
de ________________________________________________________________________________
(Calle, Ciudad, Estado, Código Postal)
necesita un reemplazo alimento los comestibles que había comprador con los beneficios de SNAP, por
$___________________, fueron destruidos en una desgracia en el hogar o infortunio.
La desgracia en el hogar o infortunio que ocurrió en ___________________fué: (Explique)
(Fecha)
___________________________________________________________________________________
___________________________________________________________________________________
Se me puede contactar al (_______) _________-________________
(Número del teléfono)
La información aquí ofrecida es correcta y cierta.
Entiendo que si hago una declaración falsa intencionalmente, sobre la pérdida de mi los comestibles
comprados con beneficios de SNAP, se me puede acusar de perjurio o sujetos a una Violación Intencional
del Programa. Si soy culpable de haber cometido una Violación Intencional del Programa, estaré
inelegible por los beneficios de SNAP por 12 meses por la primera violación, 24 meses por una segunda
violación y en forma permanente por una tercera violación.
________________________________________
________/______/_____________
Fecha
Firma del Hogar
________________________________________
________/______/_____________
Fecha
Firma del Testigo
La desgracia occurrida en el hogar mencionada anteriormente fué confirmada por:
Visita al hogar en ______/______/___________
Fecha
Contacto collateral con ______________________________en ______/______/___________
Nombre
Fecha
Documentación enviada por _____________________________en ______/______/___________
Agencia de la Comunidad
____________________________________________________
Administrador del caso
SNAP-9B (S)(Rev. 11/2011)
09-044-1111-05
Fecha
_______/_____/___________
Fecha
Original to Case Record – Copy to Client